There has been a lot of debate about and interest in the concept of a set of core indicators that can be used on a global basis to examine overall trends in environment and health conditions worldwide. Opponents of such a concept have argued that environment and health problems and priorities for their management differ significantly in various regions of the world, as do monitoring and analytical capabilities and resource availability, making it problematic to establish a core set of indicators that have universal applicability. Problems in standardizing definitions and difficulties in ensuring quality control procedures on a worldwide basis are other complicating factors.
On the other hand, most countries, regardless of their level of development or of other sociopolitical or cultural realities, deal with certain problems that are of universal significance. In the environmental domain these might include air quality, water and sanitation, food safety, waste disposal, and toxic substances. Although the specific dimensions of these problems will differ from country to country and within countries, sets of universally applicable indicators could be valuable in terms of improving shared knowledge on factors affecting the state of the global environment and their effects. Common sets of indicators have other obvious benefits. They enable aggregation at various levels (e.g., local, country, regional, global). They also provide momentum to countries for achieving uniform and rigorous standards. There may also be national reporting requirements under international treaties that may necessitate standardized indicators internationally.
The identification of a limited number of common indicators, based on those currently accepted and widely used by countries, is thus a potentially important tool for the harmonization and rationalization of indicators. Establishing agreement on such a limited set will significantly lessen the data reporting burden on countries. Where user needs are similar, indicators should be harmonized. Efforts by government departments, agencies, nongovernment organizations, civil society, and donor communities should be coordinated and should aim at strengthening data collection and management. Existing data should be drawn on as much as possible, with due recognition to its limitations.
Although standard, internationally agreed sets of indicators fulfill a major international role for between-country comparisons, nations may need other specific indicators to enable them to develop and evaluate national policies and plans. Any core set of indicators will have to be augmented in view of particular national, regional, and local policy concerns. Some indicators naturally will be more relevant at a national or global level (e.g., climate change), whereas others will be more locally relevant (e.g., drainage problems, problems with solid waste). Many issues (e.g., ambient air pollution) may necessitate management over different levels of government. At the national level, indicators to inform the setting of policies and standards may be fundamental, whereas at the local level indicators regarding service delivery and implementation of policies may be key. Information on these indicators could be collected and obtained at different geographic levels of resolution, for example at the local, national, and global levels.
The roles and responsibilities in respect to various environment and health management functions at different levels of government, the degree of decentralization of powers and functions, and other factors such as data availability and quality influence the extent to which it makes sense to examine data at different levels for international comparison purposes. Regardless of the level at which the data are aggregated and examined, however, most information normally will need to be collected in at the lowest level of resolution as is practicable and feasible.
Obtaining relevant data at country level remains a significant problem (particularly in poor countries), although most countries have some sort of health information system, even if fairly rudimentary. Nevertheless, there are often discrepancies in diagnosis, notification, and reporting and differences in referral procedures and misclassifica-tion of diseases. Differences in environmental sampling and measurement methods often affect results, and the data sometimes are unrepresentative. For all these reasons, procedures for checking accuracy, consistency, and comparability should be introduced. Uncertainty, when it exists, should be communicated effectively to the public and decision makers who must act on the basis of this information.
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